Qianqian Yuan1, Yiqin Liao1, Rui Zhou1, Jiuyang Liu1, Jianing Tang1, Gaosong Wu2. 1. Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China. 2. Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China. wugaosong@whu.edu.cn.
Abstract
PURPOSE: The optimal surgical approach of parathyroidectomy for patients with secondary hyperparathyroidism (SHPT) has been controversial. The updated meta-analysis aimed to compare the effectiveness of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation (TPTX + AT). METHODS: A thorough systematic search was performed on the databases of PubMed, EMBASE, and Cochrane library to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the symptomatic improvement, radiological changes, hypocalcemia rate, the requirement for vitamin D analogues, time to recurrence, recurrence, persistence, and reoperation rates of SPTX versus TPTX + AT. RESULTS: A total of 18 studies with 3656 patients (1864 patients in SPTX and 1792 patients in TPTX + AT group) were included, and 15 studies were included in quantitative synthesis. No significant difference was observed in symptomatic improvement (93.3%, 89.0%; P = 0.99), radiological changes (85.4%, 85.3%; P = 0.91), hypocalcemia rate (16.6%, 18.1%; P = 0.29), persistence rate (6.1%, 2.0%; P = 0.16), time to recurrence (mean difference 1.46; P = 0.87), recurrence rate (9.2%, 7.1%; P = 0.76), and reoperation rate (5.3%, 5.8%; P = 0.66) between SPTX and TPTX + AT groups. Longer operative time (150 vs. 120 min), prolonged in-hospital stay (5.0 vs. 4.1 days), lower 1-month serum calcium level, and higher requirement for vitamin D analogues at 12 months were significantly observed in patients who underwent TPTX + AT compared to SPTX. CONCLUSIONS: The two surgical approaches were both effective at controlling SHPT in clinical and laboratory terms. However, most of the data shown were not statistically significant. It was acceptable that surgeons chose either SPTX or TPTX + AT for SHPT.
PURPOSE: The optimal surgical approach of parathyroidectomy for patients with secondary hyperparathyroidism (SHPT) has been controversial. The updated meta-analysis aimed to compare the effectiveness of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation (TPTX + AT). METHODS: A thorough systematic search was performed on the databases of PubMed, EMBASE, and Cochrane library to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the symptomatic improvement, radiological changes, hypocalcemia rate, the requirement for vitamin D analogues, time to recurrence, recurrence, persistence, and reoperation rates of SPTX versus TPTX + AT. RESULTS: A total of 18 studies with 3656 patients (1864 patients in SPTX and 1792 patients in TPTX + AT group) were included, and 15 studies were included in quantitative synthesis. No significant difference was observed in symptomatic improvement (93.3%, 89.0%; P = 0.99), radiological changes (85.4%, 85.3%; P = 0.91), hypocalcemia rate (16.6%, 18.1%; P = 0.29), persistence rate (6.1%, 2.0%; P = 0.16), time to recurrence (mean difference 1.46; P = 0.87), recurrence rate (9.2%, 7.1%; P = 0.76), and reoperation rate (5.3%, 5.8%; P = 0.66) between SPTX and TPTX + AT groups. Longer operative time (150 vs. 120 min), prolonged in-hospital stay (5.0 vs. 4.1 days), lower 1-month serum calcium level, and higher requirement for vitamin D analogues at 12 months were significantly observed in patients who underwent TPTX + AT compared to SPTX. CONCLUSIONS: The two surgical approaches were both effective at controlling SHPT in clinical and laboratory terms. However, most of the data shown were not statistically significant. It was acceptable that surgeons chose either SPTX or TPTX + AT for SHPT.
Authors: Wellington Alves Filho; Willemijn Y van der Plas; Marilia D G Brescia; Climerio P Nascimento; Patricia T Goldenstein; Ledo M Massoni Neto; Sergio S Arap; Melani R Custodio; Rodrigo O Bueno; Rosa M A Moyses; Vanda Jorgetti; Schelto Kruijf; Fabio L M Montenegro Journal: Surgery Date: 2018-08-03 Impact factor: 3.982
Authors: Adrienne L Melck; Sally E Carty; Raja R Seethala; Michaele J Armstrong; Michael T Stang; Jennifer B Ogilvie; Linwah Yip Journal: Surgery Date: 2010-08-25 Impact factor: 3.982
Authors: Radu Mircea Neagoe; Mircea Mureșan; Septimiu Voidăzan; Ionela Pașcanu; Cristina Pop Radu; Daniela Tatiana Sala Journal: Endokrynol Pol Date: 2016 Impact factor: 1.582
Authors: Pascal Probst; Steffen Zaschke; Patrick Heger; Julian C Harnoss; Felix J Hüttner; André L Mihaljevic; Phillip Knebel; Markus K Diener Journal: Langenbecks Arch Surg Date: 2019-03-01 Impact factor: 3.445
Authors: T Weber; C Dotzenrath; H Dralle; B Niederle; P Riss; K Holzer; J Kußmann; A Trupka; T Negele; R Kaderli; E Karakas; F Weber; N Rayes; A Zielke; M Hermann; C Wicke; R Ladurner; C Vorländer; J Waldmann; O Heizmann; S Wächter; S Schopf; W Timmermann; D K Bartsch; R Schmidmaier; M Luster; K W Schmid; M Ketteler; C Dierks; P Schabram; T Steinmüller; K Lorenz Journal: Langenbecks Arch Surg Date: 2021-04-21 Impact factor: 3.445